Archive for June, 2012

Polyarthritis in four patients with chikungunya arthritis.

Singapore Med J. 2012 Apr  V.53 N.4 P.241-3.

Lui NL, Leong HN, Thumboo J.

Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608. lui.nai.lee@sgh.com.sg

Abstract

The incidence of chikungunya infection inSingaporehas been on the rise since the first reported case in 2006. Acute polyarthritis, a common manifestation among affected patients, may precede fever and present with debilitating arthritis to rheumatologists, orthopaedists, internists and primary care physicians. The diagnosis of chikungunya infection requires careful history taking and a high index of suspicion, with supporting evidence from the reverse transcription-polymerase chain reaction or the chikungunya IgM serology test. Treatment of chikungunya arthritis usually involves non-steroidal anti-inflammatory drugs. Rarely, polyarthritis in chikungunya may persist even after resolution of the acute infection, necessitating treatment with disease-modifying anti-rheumatic drugs. In this article, we present the different manifestations of chikungunya arthritis in our local setting and review the literature.

PDF

http://smj.sma.org.sg/5304/5304cs1.pdf

June 30, 2012 at 10:06 pm

Antistreptolysin O titer in health and disease: levels and significance.

Pediatr Rep. 2012 Jan 2 V.4 N.1 e8.

Kotby AA, Habeeb NM, Ezz El Elarab S.

Pediatric Department, Ain Shams University, Early Cancer Detection Unit Ain Shams University Hospital, Cairo, Egypt.

Abstract

Over diagnosis of acute rheumatic fever (ARF) based on a raised antistreptolysin O titer (ASOT) is not uncommon in endemic areas. In this study, 660 children (aged 9.2 ±1.7 years) were recruited consecutively and classified as: G1 (control group, n=200 healthy children), G2 (n=20 with ARF 1(st) attack), G3 (n=40 with recurrent ARF), G4 (n=100 with rheumatic heart disease (RHD) on long acting penicillin (LAP)), G5 (n=100 with acute follicular tonsillitis), and G6 (n=200 healthy children with history of repeated follicular tonsillitis more than three times a year). Serum ASOT was measured by latex agglutination. Upper limit of normal (ULN) ASOT (80(th) percentile) was 400 IU in G1, 200 IU in G4, and 1600 IU in G6. Significantly high levels were seen in ARF 1st attack when compared to groups 1 and 5 (P<0.001 and P<0.05, respectively). ASOT was significantly high in children over ten years of age, during winter and in those with acute rheumatic carditis. ASOT showed significant direct correlation with the number of attacks of tonsillitis (P<0.05). Egyptian children have high ULN ASOT reaching 400 IU. This has to be taken into consideration when interpreting its values in suspected ARF. A rise in ASOT is less prominent in recurrent ARF compared to 1st attack, and acute and recurrent tonsillitis. Basal levels of ASOT increase with age but the pattern of increase during infection is not age dependent.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357621/pdf/pr-2012-1-e8.pdf

June 30, 2012 at 10:03 pm

Antiretroviral therapy and HIV/hepatitis B virus coinfection.

Clin Infect Dis. 2004 Mar 1  V.38 Suppl 2  S98-103.

 

Benhamou Y.

Service d’Hepato-Gastroenterologie, Hopital Pitie-Salpetriere, Paris, France. ybenhamou@teaser.fr

 

http://cid.oxfordjournals.org/content/38/Supplement_2/S98.full.pdf+html

June 30, 2012 at 10:00 pm

Acute Hepatitis B and Acute HIV Coinfection in an Adult Patient: A Rare Case Report.

Case Report Med. 2010  

Bansal R, Policar M, Mehta C.

Department of Medicine, Mount Sinai Elmhurst Hospital Center, 7901 Broadway, Elmhurst, NY 11373, USA.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975075/pdf/CRM2010-820506.pdf

June 30, 2012 at 9:57 pm

A rational approach to PML for the clinician

Cleveland Clinic Journal of Medicine Nov. 2011 V.78 N. Suppl.2 P.

LEONARD CALABRESE

Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;R.J. Fasenmyer Chair of Clinical Immunology, Department of Rheumatic and Immunologic Diseases, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH

The first step in the management of progressive multifocal leukoencephalopathy (PML) is awareness of the disease. Patients vulnerable to PML are those with immunosuppression, either through their disease or use of immune-modulating therapy. In patients susceptible to PML who exhibit focal neurologic signs and symptoms, brain magnetic resonance imaging can detect the telltale PML brain lesions—subcortical white matter hyperintense areas on T2-weighted images and fluid-attenuated inversion recovery sequences and hypointensity on T1-weighted images, typically without enhancement. Demonstration of JC virus DNA by ultrasensitive polymerase chain reaction in cerebrospinal fluid is diagnostic for PML. Immune restoration whenever possible is the cornerstone of treatment. Highly active antiretroviral therapy has dramatically improved the prognosis for patients infected with human immunodeficiency virus. Alternatively, restoration of immunity is frequently attended by the immune reconstitution inflammatory syndrome which can be clinically devastating or even fatal. In the case of natalizumab-associated PML, withdrawal of therapy and prompt institution of plasmapheresis to desaturate target receptors provides the best chance for long-term survival.

PDF

http://www.ccjm.org/content/78/Suppl_2/S38.full.pdf+html

June 30, 2012 at 1:54 pm

Incidence of endophthalmitis after cataract surgery (2002-2008) at a Brazilian university-hospital.

Arq Bras Oftalmol. 2010 Dec;73(6):505-7.

Melo GB, Bispo PJ, Regatieri CV, Yu MC, Pignatari AC, Höfling-Lima AL.

Source

Department of Ophthalmology, Universidade Federal de São Paulo, SP, Brazil. gustavobmelo@oftalmo.epm.br

Abstract

PURPOSE:

To report on the incidence, diagnostic technique, and microbiological features of endophthalmitis at a university-setting inBrazil.

METHODS:

All cases of presumed postoperative endophthalmitis from 2002 to 2008 at a teaching-hospital were included. Main data assessed were: number of cataract surgeries performed, incidence of endophthalmitis, microbiological outcome (aqueous and/or vitreous culture and Gram staining), and antimicrobial susceptibility testing of the positive cases.

RESULTS:

Seventy-three eyes of 73 patients (43 females and 30 males) developed endophthalmitis after 24,590 cataract surgeries. The incidence decreased from 0.49% in 2003 to 0.17% in 2006 and stabilized afterwards. Coagulase negative Staphylococci (CoNS) and Streptococcus viridans (56.5% and 15%, respectively) were the most common bacterial isolates. Culture and Gram stain were negative in 36.9%. CoNS presented susceptibility rates of 80%-sensitivity to oxacillin, 90% to fourth-generation quinolones and 100% to vancomycin.

CONCLUSIONS:

The rate of endophthalmitis, diagnostic ability of conventional laboratory investigation, microbial isolates and antibiotic susceptibility are in accordance with other findings of the literature. Despite using prophylactic antibiotic drops, it was possible to identify cases that were susceptible to the antibiotics topically applied.

PDF

http://www.scielo.br/pdf/abo/v73n6/v73n6a07.pdf

CONCLUSION:

Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009999/pdf/opth-4-1505.pdf

June 30, 2012 at 1:52 pm

Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery.

Clin Ophthalmol. 2010 Dec 10;4:1505-14.

Olson R, Donnenfeld E, Bucci FA Jr, Price FW Jr, Raizman M, Solomon K, Devgan U, Trattler W, Dell S, Wallace RB, Callegan M, Brown H, McDonnell PJ, Conway T, Schiffman RM, Hollander DA.

Source

The John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA. randallj.olson@hsc.utah.edu

Abstract

PURPOSE:

The purpose of this study is to characterize the bacterial flora of the ocular and periocular surface in cataract surgery patients and to determine the prevalence of methicillin resistance among staphylococcal isolates obtained from health care workers (HCWs) and non-HCWs.

METHODS:

In this prospective, multicenter, case series study, eyelid and conjunctival cultures were obtained from the nonoperative eye of 399 consecutive cataract patients on the day of surgery prior to application of topical anesthetics, antibiotics, or antiseptics. Speciation and susceptibility testing were performed at the Dean A. McGee Eye Institute. Logistic regression was utilized to evaluate whether any factors were significant in predicting the presence of methicillin-resistant staphylococcal isolates.

RESULTS:

Staphylococcus epidermidis (62.9%), followed by S. aureus (14.0%), was the most frequently isolated organism. Methicillin-resistant S. epidermidis accounted for 47.1% (178/378) of S. epidermidis isolates, and methicillin-resistant S. aureus accounted for 29.5% (26/88) of S. aureus isolates. Methicillin-resistant staphylococcal isolates were found in 157 of 399 (39.3%) patients, the majority (89.2%) of whom were non-HCWs. The likelihood of being colonized with methicillin-resistant organisms increased with age (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.02-1.58; P = 0.04) but decreased with diabetes (OR, 0.51; 95% CI: 0.29-0.89; P = 0.02). Being a HCW (OR, 1.25; 95% CI: 0.61-2.58; P = 0.54) was not a risk factor for colonization with methicillin-resistant organisms.

CONCLUSION:

Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009999/pdf/opth-4-1505.pdf

June 30, 2012 at 1:50 pm

Management of sternal osteomyelitis and mediastinal infection following median sternotomy.

Chin Med J (Engl). 2010 Oct  V.123 N.20 P.2803-6.

Gao J, Wang YL, Lu SQ, Cai AB, Yang ZF, Han ZY, Li JJ, Wen YM, Geng FY, Wang WZ.

Third Department of Surgery, Hospital of Aviation Industry Corporation of China, Beijing, China. gaoju188@sohu.com

Abstract

BACKGROUND:

Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy.

METHODS:

Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.

RESULTS:

No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.

CONCLUSIONS:

Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged sternal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

PDF

http://www.cmj.org/Periodical/PDF/2010101841435800.pdf

June 30, 2012 at 1:46 pm

Unapparent microsporidial infection among immunocompetent humans in the Czech Republic.

J Clin Microbiol. 2011 Mar  V.49  N.3  P.1064-70.

Sak B, Brady D, Pelikánová M, Květoňová D, Rost M, Kostka M, Tolarová V, Hůzová Z, Kváč M.

Biology Centre of the Academy of Sciences of the Czech Republic, v.v.i., University of South Bohemia in České Budějovice, České Budějovice, Czech Republic.

Abstract

In the present population-based study, we determined the prevalences of the most common human-pathogenic microsporidia, Encephalitozoon spp. and Enterocytozoon bieneusi, in asymptomatic healthy people living in theCzech Republic. A total of 382 males and females (ages, 1 to 84 years) living in the Czech Republic, of whom 265 were Czech nationals and 117 were foreign students, were included in a study testing for the presence of microsporidia by use of coprology and molecular methods. Single-species infections with Enterocytozoon bieneusi or an Encephalitozoon sp. were detected for 9 and 136 individuals, respectively. Moreover, coinfections were detected for 14 individuals. Four genotypes of 3 human-pathogenic Encephalitozoon spp. and 7 E. bieneusi genotypes, including 3 novel genotypes, were detected. Some of these were reported in humans for the first time. The highest prevalence was recorded for individuals older than 50 years and for loose, unformed stool samples. These findings clearly show that exposure to microsporidia is common among immunocompetent people and that microsporidiosis is not linked to any clinical manifestation in healthy populations.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067711/pdf/zjm1064.pdf

June 30, 2012 at 1:43 pm

Microsporidian species known to infect humans are present in aquatic birds: implications for transmission via water?

Appl Environ Microbiol. 2006 Jul  V.72 N.7  P.4540-4.

Slodkowicz-Kowalska A, Graczyk TK, Tamang L, Jedrzejewski S, Nowosad A, Zduniak P, Solarczyk P, Girouard AS, Majewska AC.

Departmetn of Biology and Medical Parasitology, Poznan University of Medical Sciences, Poznan, Poland.

Abstract

Human microsporidiosis, a serious disease of immunocompetent and immunosuppressed people, can be due to zoonotic and environmental transmission of microsporidian spores. A survey utilizing conventional and molecular techniques for examining feces from 570 free-ranging, captive, and livestock birds demonstrated that 21 animals shed microsporidian spores of species known to infect humans, including Encephalitozoon hellem (20 birds; 3.5%) and Encephalitozoon intestinalis (1 bird; 0.2%). Of 11 avian species that shed E. hellem and E. intestinalis, 8 were aquatic birds (i.e., common waterfowl). The prevalence of microsporidian infections in waterfowl (8.6%) was significantly higher than the prevalence of microsporidian infections in other birds (1.1%) (P < 0.03); waterfowl fecal droppings contained significantly more spores (mean, 3.6 x 10(5) spores/g) than nonaquatic bird droppings contained (mean, 4.4 x 10(4) spores/g) (P < 0.003); and the presence of microsporidian spores of species known to infect humans in fecal samples was statistically associated with the aquatic status of the avian host (P < 0.001). We demonstrated that a single visit of a waterfowl flock can introduce into the surface water approximately 9.1 x 10(8) microsporidian spores of species known to infect humans. Our findings demonstrate that waterborne microsporidian spores of species that infect people can originate from common waterfowl, which usually occur in large numbers and have unlimited access to surface waters, including waters used for production of drinking water.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489349/pdf/2503-05.pdf

June 30, 2012 at 1:41 pm

Older Posts


Calendar

June 2012
M T W T F S S
 123
45678910
11121314151617
18192021222324
252627282930  

Posts by Month

Posts by Category